Society of Diabetic Nephropathy Prevention Journal of Nephropathology 2251-8363 15 4 2026 10 01 Monitoring rituximab levels in primary membranous nephropathy; is it necessary for finding the perfect dose for lasting remission e27683 e27683 10.34172/jnp.27683 EN Swathi Nayak Ammunje https://orcid.org/0009-0009-1071-7818 Shankar Prasad Nagaraju https://orcid.org/0000-0003-1016-8280 Dharshan Rangaswamy https://orcid.org/0000-0002-6152-7493 Ravindra Prabhu Attur https://orcid.org/0000-0002-5980-7197 Indu Ramachandra Rao https://orcid.org/0000-0001-5061-739X Mohan Varadanayakanahalli Bhojaraja https://orcid.org/0000-0002-1814-2360 Srinivas Vinayak Shenoy https://orcid.org/0000-0001-7405-4106 Shriya Narendra Shet Shirodkar https://orcid.org/0009-0002-7882-6745 Priya Rani https://orcid.org/0000-0002-6202-5700 Sindhura Lakshmi Koulmane Laxminarayana https://orcid.org/0000-0002-8925-0000 Journal Article 10.34172/jnp.27683 2025 09 12 2026 06 24 Primary membranous nephropathy (pMN) is characterized by thickening of the glomerular capillary wall and a variable course of disease. Rituximab, an anti-CD20 monoclonal antibody (mAb), has been shown to have therapeutic effects; however, optimal dosing regimens and monitoring practices remain uncertain. To assess the usefulness of rituximab level monitoring in pMN and determine the factors associated with variations in treatment effects. A literature review was conducted on studies comparing rituximab pharmacokinetics, monitoring methods, and clinical outcomes in pMN. Information on drug clearance, urinary loss, inactivation by antibodies, and Fc receptor polymorphisms were reviewed. Our review showed, ELISA is the most commonly employed method for rituximab quantification. However, uncertainty remains due to the large inter-patient variability. Drug availability is affected by urinary loss, internalization by B cells, anti-drug antibodies, and Fc receptor polymorphisms. Regular monitoring has been shown to reduce under- and over-treatment, favoring individualized therapies. Therefore, monitoring rituximab levels may facilitate precision-based treatment in pMN. Additionally, standardized protocols are needed for directing dosing, maintenance, and monitoring practices.